Mohamad Irani1, Shad Deering2. 1. Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA. Electronic address: mohamad.irani@hotmail.com. 2. Department of Obstetrics and Gynecology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Abstract
BACKGROUND: Most maternal deaths occur in low-income countries where access to appropriate medical care is restricted. OBJECTIVES: To evaluate rates of cesarean deliveries and identify barriers to this mode of delivery in low-income countries. SEARCH STRATEGY: A review of Medline and PubMed was performed to identify reports published in English or French using the keywords "cesarean section," "maternal mortality," and "developing countries." SELECTION CRITERIA: Studies investigating the obstacles to cesarean delivery and plans to overcome them in low-income countries were included. DATA COLLECTION AND ANALYSIS: Data from included studies were extracted and analyzed. MAIN RESULTS: Studies from 16 countries in Sub-Saharan Africa were included. The average rate of cesarean delivery was 3.6% (range 1.5%-7.1%). The rate was negatively correlated with the maternal mortality ratio (r=-0.63; P=0.005), neonatal mortality rate (r=-0.81; P<0.001), and infant mortality rate (r=-0.80; P<0.001). Major barriers to achieving higher rates of cesarean deliveries include poverty, limited access to healthcare services, and a shortage of skilled providers. CONCLUSIONS: Maternal and infant mortality rates could be lowered by increasing access to cesarean delivery. Additional education of patients and providers, establishment of more heath facilities, and governmental support of obstetric care could help to reach this goal.
BACKGROUND: Most maternal deaths occur in low-income countries where access to appropriate medical care is restricted. OBJECTIVES: To evaluate rates of cesarean deliveries and identify barriers to this mode of delivery in low-income countries. SEARCH STRATEGY: A review of Medline and PubMed was performed to identify reports published in English or French using the keywords "cesarean section," "maternal mortality," and "developing countries." SELECTION CRITERIA: Studies investigating the obstacles to cesarean delivery and plans to overcome them in low-income countries were included. DATA COLLECTION AND ANALYSIS: Data from included studies were extracted and analyzed. MAIN RESULTS: Studies from 16 countries in Sub-Saharan Africa were included. The average rate of cesarean delivery was 3.6% (range 1.5%-7.1%). The rate was negatively correlated with the maternal mortality ratio (r=-0.63; P=0.005), neonatal mortality rate (r=-0.81; P<0.001), and infant mortality rate (r=-0.80; P<0.001). Major barriers to achieving higher rates of cesarean deliveries include poverty, limited access to healthcare services, and a shortage of skilled providers. CONCLUSIONS: Maternal and infant mortality rates could be lowered by increasing access to cesarean delivery. Additional education of patients and providers, establishment of more heath facilities, and governmental support of obstetric care could help to reach this goal.
Authors: Margo S Harrison; Omrana Pasha; Sarah Saleem; Sumera Ali; Elwyn Chomba; Waldemar A Carlo; Ana L Garces; Nancy F Krebs; K Michael Hambidge; Shivaprasad S Goudar; Bhala Kodkany; Sangappa Dhaded; Richard J Derman; Archana Patel; Patricia L Hibberd; Fabian Esamai; Edward A Liechty; Janet L Moore; Dennis Wallace; Elizabeth M Mcclure; Menachem Miodovnik; Marion Koso-Thomas; Jose Belizan; Antoinette K Tshefu; Melissa Bauserman; Robert L Goldenberg Journal: Acta Obstet Gynecol Scand Date: 2017-03-09 Impact factor: 3.636
Authors: Maarten D H Vink; Piet J G M de Bekker; Xander Koolman; Maurits W van Tulder; Ralph de Vries; Ben Willem J Mol; Eric J E van der Hijden Journal: BMC Pregnancy Childbirth Date: 2020-08-20 Impact factor: 3.007